ACS罪犯血管行PCI中出现无复流现象相关因素的Logistic分析

Correlation factor of occurrence of no reflow during criminal vessal PCI in patients with ACS

目的探讨ACS罪犯血管行PCI中出现无复流现象的相关因素。方法选择2003年7月至2007年2月1783例急性冠状动脉综合征(ACS)行PCI的临床和冠状动脉造影(CAG)资料。PCI过程中出现无复流患者共63例(无复流组),从其余的PCI后冠脉血流TIMI3级患者中随机抽取70例作为正常血流组。观察年龄、性别、体质量指数、吸烟史、糖尿病史等基本情况,血脂水平、血糖水平、apoA、血常规(WBC等)等生化指标,罪犯血管病变及PCI情况。结果单因素分析结果显示:无复流组与正常血流组年龄、男性、吸烟史、BMI、血糖、高血压史收缩压、舒张压、脉压差、脉压指数、平均动脉压、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、脂蛋白A、心绞痛病程、心绞痛分级、病变长度、支架直径、支架长度、支架总数、球囊预扩张、释放压、支架种类、病变部位、侧枝循环形成、PCI史差异无统计学意义(P>0.05),多因素分析结果:糖尿病(P=0.013,Exp(B)=8.917)、冠状动脉钙化(P=0.003,Exp(B)=8.235)、白细胞水平(P<0.001,Exp(B)=2.125)、狭窄程度(P=0.021,Exp(B)=1.145)、PCI前TIMI(P=0.013,Exp(B)=0.329)组间差异有统计学意义。对糖尿病患者PCI统计结果显示,无复流组与正常血流组血糖水平无明显统计学显著性差异(t=0.973,P=0.344)。进一步对急性心肌梗死患者行罪犯血管PCI与出现无复流的关系进行多因素分析结果:Q计数(P=0.008,Exp(B)=5.241)、梗死前心绞痛(P=0.023,Exp(B)=0.005)组间差异有统计学意义。结论ACS罪犯血管行PCI过程中,急性心肌梗死、糖尿病、白细胞水平、冠状动脉钙化、冠状动脉狭窄程度、PCI前TIMI是无复流现象的独立影响因子,急性心肌梗死更容易出现无复流。无复流的发生仅与是否合并糖尿病有关,与血糖的控制水平无明显相关。梗死前心绞痛是无复流现象的独立保护因子。

Objective Approach the correlation factor of occurrence of no reflow during criminal vessal PCI in patients with ACS. Methods Identified 1 782 patients with ACS in whom PCI were performed during July 2003 and February 2007, according to the occurrence of no-reflow during PCI,we designated 63 patients in whom no-reflow occurred during PCI among the 1 782 patients as no-reflow group, 70 patients were random drawn-off from the rest of the 1 782 patients were designated as control group, two groups were observed and contrasted by the following items ： age, gender, body mass index （ BMI ） , smoking, diabetes mellitus, blood glucose, hypertension,systolic pressure, diastolic pressure, pulse pressure, pulse pressure index, hyperlipemia, blood fat level, apoA, WBC, angina pectoris grading,angina pectoris course, AMI, the number of Q wave, ∑ST elevation, the number of ∑ST elevation,location of criminal vessel,the degree of stenosis of criminal vessel,the number of vessel with lesions, status of choiced stents （ dilated pressure, dilated frequency, stents type, stents diameter, stents length, release pressure, the number of stents etc） , calcification, thrombus in coronary artery, compensatory circulation,multiple logistic regression analysis was used to identify independent relative factor of the no reflow phenomenon by SPSS 10.0. Results Univariate analysis demonstrated that age, gender, body mass index （BMI） , smoking,blood glucose, systolic pressure, diastolic pressure, pulse pressure, pulse pressure index, hyperlipemia,blood fat level,apoA, WBC, angina pectoris grading, angina pectoris course, the number of vessel with lesions, status of choiced stents （ dilated pressure, dilated frequency, stents type, stents diameter, stents length, release pressure, the number of stents etc） , compensatory circulation were not related to the no reflow phenomenon （P 〉 0. 05 ） , multiple logistic regression analysis indicated that diabetes mellitus （ P = 0. 013, Exp （ B ） = 8.917 ） , WBC （ P 〈 0. 001, Exp （ B ） = 2. 125 ） , calcification （ P = 0. 003, Exp （ B ） = 8. 235 ） , the degree of stenosis of criminal vessel（ P=0. 021 ,Exp（B） = 1. 145） ,TIMI before PCI（ P =0. 013 ,Exp（B） =0. 329） were related to the no reflow phenomenon in ACS, the number of Q wave （ P= 0. 008, Exp （B） = 5. 241 ） , the preinfaction agina（ P = 0. 023 ,Exp（B） =0. 005）were related to the no reflow phenomenon in AM I,the diference of blood glucose were not demonstrated between the no-reflow group and control group in patients with diabetes mellitus（t = 0. 973,P = 0. 344）. Conclusion AMI, diabetes mellitus, WBC, calcification, the degree of stenosis of criminal vessel ,TIMI before PCI were related risk factor,the preinfaction agina was related protectant factor, the occurrence of no-reflow related to diabetes mellitus,but blood glucose didn＇t indicate the relationship to no-reflow.